We conducted a cross-sectional analysis of the baseline survey of participants aged > 30 years enrolled in the Mwanza HIV&CVD Cohort in Tanzania. Our primary objective was to examine the association between HIV status and sleep apnea (SA). Secondary objectives were (1) to examine the association between HIV status and excessive daytime sleepiness (EDS) and (2) to identify risk factors associated with SA and with EDS. The cohort enrolled 500 people living with HIV (PLWH) and 500 people without HIV (PWoH) in 2021-2023. Participants completed overnight oximetry; SA was defined as an oxygen desaturation index (ODI) of ≥ 5 events/h. EDS was defined as an Epworth Sleepiness Scale score (ESS) of ≥ 11. The median age was 46 and 43 in PLWH and PWoH, respectively. The prevalence of sleep apnea was similar between PLWH and PWoH (17% and 19%, respectively; adjusted odds ratio (aOR) = 0.84, 95% confidence interval (CI) = 0.60-1.17). In contrast, the prevalence of EDS (ESS score ≥ 11) was higher in PWoH (21%) than in PLWH (13%) (aOR = 0.58, 95% CI = 0.41-0.83). In a multivariable model, factors associated with SA were older age, alcohol use, higher BMI category, hypertension and depression. Both objectively measured SA and subjectively reported EDS are common in Tanzanian adults. SA was strongly associated with overweight or obesity, suggesting that the prevalence of SA will grow with projected increases in age and obesity rates in Tanzania.

Effect of Lactate Metabolism on Hypoxia-induced Inflammation in the Oral Mucosa.

Mandibular advancement devices and treatment-emergent central sleep apnea (TECSA): Coincidental or critical finding?

• Epilepsy is one of the most common chronic neurological disorders, affecting approximately 1–3 % of the global population and representing a major cause of long-term neurological morbidity worldwide. • Vagus nerve stimulation (VNS) is an established adjunctive therapy for drug-resistant epilepsy (DRE). • While generally safe, stimulation of the cervical vagus nerve may be associated with adverse events involving multiple organ systems, necessitating accurate risk contextualisation and patient-centred management. • Stimulation-related airway symptoms including hoarseness, cough, dyspnoea, stridor, and sleep-disordered breathing were the most frequently reported adverse effects and were typically transient or reversible through adjustment of output current, pulse width, duty cycle, or temporary magnet-controlled suspension. • VNS provides meaningful seizure reduction for a substantial proportion of patients with DRE. Optimal long-term outcomes depend on realistic communication of complication risks, careful differentiation between common stimulation-related effects and rare surgical or device failures, and timely, patient-centred adjustment of therapy throughout the device lifespan. Vagus nerve stimulation (VNS) is an established adjunct for drug-resistant epilepsy (DRE), yet its “wandering” effects across organ systems generate a wide range of adverse events. To collate published VNS-related complications and present pragmatic, system-based management guidance. PubMed, Scopus, and Web of Science were searched from inception to 30 June 2025 for human studies reporting surgical, device-related, or stimulation-linked problems after cervical VNS in DRE or treatment-resistant depression. Two reviewers independently screened, extracted, and synthesised data in this narrative review. Airway sequelae—hoarseness, cough, dyspnoea, stridor and sleep apnoea—were the most typical reactions; most resolved after reducing output current, pulse width or duty-cycle, or by magnet-controlled pauses. Device failures comprised lead fracture (up to 11.9 % in paediatric cohorts), generator battery depletion prompting replacement in 15–27 % of long-term users, and infections in 2–6 % of implants. Rare but serious cardiac events—bradycardia or intra-operative asystole (manufacturer estimate 0.1–1 %)—were reversible when stimulation ceased. Isolated neurological, psychiatric, and gastrointestinal events (pain, tremor, mania, intractable hiccups, diarrhoea) were typically mitigated by parameter adjustment or explantation. Roughly half of DRE patients attain ≥50 % seizure reduction with VNS, but durable benefit hinges on vigilant, system-specific surveillance and early tailored interventions. A structured, organ-oriented approach helps multidisciplinary teams balance seizure control, safety, and quality of life throughout the device’s lifespan

Ocular conditions associated with obstructive sleep apnea: Mechanisms and clinical implications.

Splenic enlargement as a physiologic adaptation to obstructive sleep apnea and nocturnal hypoxemia: A retrospective cohort study.

New definition, diagnostic criteria, and diagnostic workflows for patients with suspected COMISA.

Gout is a chronic inflammatory disease characterized by the deposition of monosodium urate crystals in the joints. However, growing research suggests a more complex pathophysiology involving genetic susceptibility, metabolic stress, and environmental factors. Among emerging contributors, hypoxia-inducible factor 1 alpha (HIF-1α) has been proposed as a potential regulator that links these processes, though its role in gout remains underexplored. This review examines the emerging evidence supporting HIF-1α's role in both urate production and inflammation, to offer a unifying framework connecting these contributors to gout pathogenesis. Systemically, HIF-1α has been shown to promote a metabolic shift towards glycolysis and purine metabolism, providing a plausible mechanism for hyperuricemia. Locally, metabolic priming helps sustain immune responses, particularly through the release of interleukin-1 beta. Environmental stressors, including hypoxia and pseudohypoxia (e.g., obstructive sleep apnea), can further stabilize HIF-1α and amplify inflammatory signaling. This framework supports a model in which HIF-1α links metabolic stress, immune activation, and environmental exposures, reframing gout as a disorder of metabolic maladaptation and suggesting HIF-1α as a potential therapeutic target.

Excessive daytime sleepiness (EDS) substantially impairs health-related quality of life and cognitive function in obstructive sleep apnea (OSA) patients. However, the underlying neuropathological mechanisms remain poorly understood. To investigate the associations between EDS, cognitive deficits, and brain alterations in OSA patients. Prospective. One hundred two OSA patients (16 female, median age (IQR) 33.00 [28.00-41.00]) and 86 healthy controls (HCs) (16 female, median age (IQR) 33.00 [25.00-50.25]) were prospectively recruited. 3 T, 3D spoiled gradient-echo, diffusion-weighted spin-echo, blood oxygen level-dependent gradient-echo planar. The Epworth Sleepiness Scale, multiparameter MRI, and a series of neuropsychological tests (the number connection tests A and B, digit symbol test, line tracing test, serial dotting test, and Stroop Color/Word test) were performed to evaluate EDS, brain alterations, and cognitive performances. Mann-Whitney U test, independent samples t-test, chi-square test, Spearman's correlation, and mediation analyses were used. Significance level: p < 0.05. OSA patients exhibited statistically poorer cognitive performance (effect size = 0.23-0.37), lower diffusion tensor imaging along the perivascular space (DTI-ALPS) index (effect size = 0.25), and abnormal network topology (effect size = -0.80 to 0.57) compared with HCs. EDS significantly correlated with poorer cognitive performance (r = -0.173 to 0.258), lower DTI-ALPS index (r = -0.199), and abnormal network topology (r = -0.364 to 0.279) in all participants. Furthermore, aberrant degree centrality and nodal efficiency in the bilateral middle frontal gyrus (MFG) and left inferior parietal lobule (IPL) may mediate the relationship between EDS and cognitive deficits (indirect effect = -0.13 to 0.36). These results demonstrate that cognition, DTI-ALPS index, and network topology were all compromised in OSA. Furthermore, abnormal network topology in the bilateral MFG and left IPL may mediate the relationship between EDS and cognitive deficits. Level 2. Stage 2.

Simultaneous hypoxemia and hypercapnia frequently occur in conditions such as obstructive sleep apnea, which may cause peripheral and cerebral vascular dysfunction. However, how hypoxemia and hypercapnia interact in regulating peripheral and cerebral vascular responses remains incompletely understood. Eleven healthy young adults (4 females) completed three resting gas-inhalation trials (5-6 min) under different arterial O2 and CO2 conditions: 1) hypoxemic normocapnia (percutaneous arterial oxygen saturation ∼85%; Hypoxemia), 2) normoxic hypercapnia (end-tidal CO2 partial pressure ∼55 mmHg; Hypercapnia), and 3) hypoxemic hypercapnia (Combined). Femoral artery blood flow and middle cerebral artery mean blood velocity were continuously assessed using Doppler ultrasound and transcranial Doppler ultrasonography, respectively. These values were divided by mean arterial pressure measured by finger photoplethysmography to calculate leg vascular conductance and cerebrovascular conductance index (CVCi). Total vascular conductance was calculated as cardiac output (model-flow method) divided by mean arterial pressure. Relative to before gas inhalation, leg vascular conductance remained unchanged in all trials, whereas total vascular conductance increased during Hypoxemia. CVCi increased during Hypercapnia and Combined. When comparing the summed isolated responses (Hypoxemia + Hypercapnia) with the Combined, changes from baseline (Δ values) of leg vascular conductance tended to be lower (P = 0.054), and total vascular conductance was lower (P = 0.031) in Combined. By contrast, Δ CVCi did not differ between the summed isolated vs. Combined (P = 1.000). We show that hypoxemia and hypercapnia interact to augment systemic vasoconstriction, whereas hypercapnia-induced cerebral vasodilation is well preserved when combined with hypoxemia.NEW & NOTEWORTHY Combined hypoxemia and hypercapnia, which occurs in obstructive sleep apnea, tended to produce greater reductions in leg vascular conductance and a significantly greater reduction in total vascular conductance compared with the sum of the isolated effects. Cerebral vascular conductance index increased to a similar extent during the combined compared with the summed conditions. We show that hypoxemia and hypercapnia interact to augment systemic vasoconstriction, whereas hypercapnia-induced cerebral vasodilation is maintained when combined with hypoxemia.

High prevalence of obstructive sleep apnea in patients with Long-COVID.

Early experience with hypoglossal nerve stimulation in Japanese patients: Trends in operative time and treatment outcomes.

Adenotonsillectomy is one of the most common elective pediatric surgeries. However, its routine occurrence can mask substantial preventable risks arising from practitioner inexperience, underappreciated comorbidities, airway proximity to the surgical field, and challenging postoperative pain management. This review highlights common "error traps" that contribute to perioperative adverse events and outlines evidence-based mitigation strategies. Key preoperative challenges include unrecognized moderate-to-severe obstructive sleep apnea (OSA) and recent upper respiratory infections (URIs), both of which markedly increase perioperative respiratory adverse events (PRAEs). Intraoperative hazards include challenging airway management at induction and emergence, risk of airway fire, and excessive opioid administration. Postoperatively, inadequate analgesia and inappropriate disposition planning remain major preventable causes of morbidity. Perioperative management of the child with post-tonsillectomy hemorrhage is uniquely challenging. Structured OSA and URI screening and mitigation strategies, multimodal opioid-sparing analgesia, and institution-specific discharge algorithms are strongly recommended. A systematic, team-based approach emphasizing awareness of cognitive biases, vigilance, protocolized management, and hospital outcome monitoring can significantly reduce preventable complications and improve safety in pediatric adenotonsillectomy.

Effects of a Time-Restricted Eating Intervention on Sleep and Body Composition in Adults with Obstructive Sleep Apnea: A Randomized Cross-over Clinical Trial.

A Physiology-Informed Prediction Model for Postoperative Respiratory Complications in Obese Patients With Obstructive Sleep Apnea.

There is increasing interest in the use of artificial intelligence (AI) to assist with respiratory diagnosis and risk prediction. Fuzzy logic is a form of AI that has the advantage of being transparent and interpretable, compared to alternatives such as deep neural networks. We systematically reviewed applications of fuzzy logic for outcome prediction in respiratory medicine. We searched PubMed and IEEE Xplore from inception to November 2024 for studies which applied fuzzy logic to respiratory outcome prediction and diagnosis. Three reviewers independently screened titles and abstracts, then all five reviewers assessed full texts for eligibility. Risk of bias was assessed using PROBAST by three reviewers. We performed a narrative synthesis following the SWiM guidelines due to heterogeneity. From 982 records, 29 studies (1998-2024) met the inclusion criteria. Studies addressed asthma (n=5), obstructive sleep apnoea (n=8), lung cancer (n=4) and a variety of other conditions. Mamdani-type systems were the most frequently used (69%). Performance varied dramatically, with sensitivity/specificity ranging from 69 to 100% and 19-100%, respectively. The studies which displayed the highest accuracy (>95%) incorporated well-defined clinical variables, particularly for asthma and tuberculosis. However, 69% of studies displayed high risk of bias, frequently due to inadequate validation. Fuzzy logic systems show potential as a transparent alternative to neural network-based machine learning for outcome prediction and diagnosis in respiratory medicine. However, clinical implementation is limited by frequent methodological limitations. Future research requires prospective validation studies and standardised reporting before fuzzy logic can enhance respiratory medicine.

Obstructive sleep apnea increases recurrent cardiovascular event risk in younger but not older patients with acute coronary syndrome: a prospective cohort study.

Cognition in the time of dysbiosis: Sleep disruption and the gut-brain dialogue.

Understanding gut microbiota dysbiosis as a plausible link between obstructive sleep apnea (OSA), viral infections, and lifestyle diseases.

Could Glucagon-Like Peptide-1 (GLP-1) receptor antagonists be used to treat obstructive sleep apnoea in children and adolescents with obesity?